World Congress at ACG2017

Symposium 2D: Live From Orlando! The 5th Annual Endoscopy Video Forum

V4 - Office Management of Acute Thrombosed Hemorrhoids in a Pregnant Patient

Monday, October 16
5:28 PM - 5:35 PM
Location: W414 (Level 4)

Category: Endoscopy Video Forum       Sub-Category: ACG abstr 2017.mp4

Waqar Qureshi, MD, FACG, FRCP
Baylor College of Medicine, Houston, TX
Training in the management of ano-rectal disease is inadequately addressed in many fellowship training programs. As a result, conditions such as hemorrhoids, acute hemorrhoid thrombosis, anal fissures, anal pruritus, and stool incontinence which are treatable in the office, are referred to the surgeon. Decompression of an acute thrombosed hemorrhoid is easily performed in the office. Attached is a video demostrating how easy and quickly this is achived.

We present a 28 year old pregnant lady at 28 weeks gestation who developed significant rectal pain about 48 hours previously. She had a history of grade 2 internal, and external hemorrhoids on previous anoscopic examination for which she had been prescribed fiber, stool softner and preperation-H ointment. Her symptoms had started abruptly following straining during a bowel movement. The patient was in severe throbbing pain and could not sit due to her pain. On examination she had a very tender thrombosed external hemorrhoid that measured 1cm x 2cm. Following informed consent the hemorrhoid was infiltrated with 1% lidocaine and incised to release a blood clot. This incision is made in an oval or triangular shape to leave a gaping wound so that it does not close over and allow another clot to form. The patient got immediate relief of her pain and was most grateful.

As the video demonstrates this is a quick and easy procedure. There is a 72 hour window from the start of symptoms in which to perform the incision and drainage. Referral to a surgeon could result in missing this window. After 72 hours the clot starts to organize and drainage is not possible. Treatment then is with analgesia and sitz baths etc. and recovery takes a few weeks. This patient will most likely need hemorrhoid banding following delivery of her baby to reduce the risk of this happening again in her next pregnancy. An ano-rectal clinic should be part of any gastroenterology practice providing comprehensive care.

Supported by Industry Grant: No

Citation: . OFFICE MANAGEMENT OF ACUTE THROMBOSED HEMORRHOIDS IN A PREGNANT PATIENT. Program No. V4. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

Waqar Qureshi

Baylor College of Medicine
Houston, TX, US

Dr. Waqar Qureshi is presently Professor of Medicine, Clinical Director and Chief of Endoscopy and Baylor College of Medicine, Houston, TX. Dr. Qureshi earned his medical degree from the University of London's Royal Free Hospital School of Medicine in the United Kingdom. He then completed his residency in Internal Medicine and fellowship training in Gastroenterology here in the U.S. He is a therapeutic endoscopist whose interests include ERCP, EMR, endoscopy in pregnancy, and non-surgical treatment of hemorrhoids. Dr. Qureshi has served on various national committees including the AGA's Education Committee and the Standards of Practice Committee of the ACG. He is fellow of the Royal College of Physicians (UK), and the ACG, and is an active member of the Texas Society of Gastroenterology and Endoscopy. As a recognized academic gastroenterologist, Dr. Qureshi has authored articles in peer-reviewed journals and is a reviewer for The American Journal of Gastroenterology, and Digestive Diseases. He conducts clinical research in the treatment and management of various gastrointestinal diseases including Helicobacter pylori infection and its complications.


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V4 - Office Management of Acute Thrombosed Hemorrhoids in a Pregnant Patient

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